Strep Throat (cont.)
John Mersch, MD, FAAP
Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Strep throat facts
- What is strep throat?
- What causes a sore throat?
- What are tonsils and tonsillitis?
- What are pharynx and pharyngitis?
- Viral causes of throat infection
- Bacterial causes of throat infection
- How common is strep throat?
- Is strep throat contagious?
- What are the signs and symptoms of strep throat?
- Are strep throat symptoms different in children compared to adults?
- When should I be concerned about a possible strep throat?
- How is strep throat diagnosed?
- Who should be tested for strep throat?
- How is strep infection treated?
- How can viral throat infection be treated?
- Are there any recommended strep throat remedies and symptom reducers?
- When should the tonsils be removed?
- Why is it very important to detect and treat a strep throat?
- What are the potential complications of untreated strep throat infection?
- Is there a vaccine for strep throat?
- Can strep throat be prevented?
- Just a Sore Throat or Strep - Slideshow
- Take the Strep Throat Infection Quiz!
- Infectious Mononucleosis - Slideshow
- Strep Throat (Streptococcal) Infection FAQs
Who should be tested for strep throat?
There are no absolute indicators to determine who should be tested for strep throat. However, there are certain predictors that make the possibility of strep tonsillopharyngitis likely. These include:
- Children and adolescents between the ages of five and 15
- Illness occurring in the late fall, winter, or early spring months
- Clinical evidence of acute pharyngitis such as:
- redness and swelling in throat, white discharge on the tonsils
- fever of 101 F to 103 F (38 C to 39.4 C)
- large and tender lymph nodes in the neck
- Sore throat accompanied by headache or upset stomach that may include nausea and vomiting.
- Absence of upper respiratory infection symptoms, such as runny nose, nasal congestion, and cough
Some clinical studies suggest that if all of these points are present, then the likelihood of strep throat may be up to 85%. The doctor may decide if testing is necessary based on these or other clinical factors.
How is strep infection treated?
Because of potential significant complications (described below), if strep throat is detected, it must be treated adequately with antibiotics. It is important to take the full course of antibiotics as prescribed and not to stop the medication when symptoms resolve. Prematurely discontinuing antibiotics can result in the infection being inadequately treated, with potentially adverse consequences or relapse of the infection.
Streptococcus is highly responsive to penicillin and the cephalosporin antibiotics. Penicillin has shown good effectiveness, and it is reliable and cheap.
Oral penicillin V (Pen-Vee-K) is the preferred oral form of penicillin for strep throat. A full 10 day course must be completed even though patients usually feel better only after two to three days.
Injectable penicillin G (CR-Bicillin) is also very effective and may be used in individuals who may not reliably take 10 days of antibiotics orally. The drug may last in the body for up to 21 days and can therefore adequately treat the infection.
Other penicillin derivatives such as amoxicillin (Amoxil) and amoxicillin-clavulanate (Augmentin) are also effective treatments for strep throat. They may be even slightly more effective than penicillin because of better absorption and greater potency. Most pediatricians prefer amoxicillin due to its superior taste and twice a day (for 10 days) regimen).
Cephalosporin antibiotics are also a very effective in treating group A streptococcus. In some studies, they were found to be better than penicillin, and there is some suggestion that they may be the first choice antibiotic for this infection. For now, they remain a very good choice in patients with mild penicillin allergies.
Some examples of cephalosporin antibiotics used to treat strep throat are:
- cephalexin (Keflex),
- cefprozil (Cefzil),
- cefuroxime (Ceftin), and
- cefdinir (Omnicef).
Other antibiotic options are members of the macrolide family, such as erythromycin (E-Mycin), azithromycin (Zithromax), and clarithromycin (Biaxin). These antibiotics have shown similar to superior effectiveness compared to penicillin for the treatment of group A streptococcus. Erythromycin is thought to be the optimum choice for people with severe penicillin allergy.
Current recommendations still list penicillin or amoxicillin as first choice for the treatment of group A streptococcus. Erythromycin is recommended as the first choice in penicillin-allergic individuals. First generation cephalosporins such as cephalexin are alternatives to erythromycin.
It is extremely important to complete the full course of antibiotics when treating strep throat. Most patients experience a rapid reduction in the symptoms and are not contagious after completing their first day of therapy.
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